| (a) Individual choice. An LMHA shall give consumers
the opportunity to choose from any available provider in the LMHA's
provider network offering services for which the individual is authorized
at the time of admission and at least annually thereafter.
(b) Changing providers. Individuals may request and
change providers at any time.
(c) Provider information. An LMHA shall maintain a
current list of providers and a provider profile for each provider
in the network, including the LMHA, on its website. The LMHA's website
must also provide instructions for requesting a change in providers
as described in §401.464 of this title (relating to Notification
and Appeals Processes).
(1) The provider list must include the following information
about each provider:
(A) name;
(B) service locations and the services provided at
each location; and
(C) contact information, including the provider's website
address.
(2) The provider profile is a standardized form completed
by the provider, may include information such as staffing patterns,
special features of service delivery, and cultural and linguistic
specialization. An LMHA shall use the provider profile template established
by the department at the beginning of the planning cycle. The LMHA
may add additional items to the provider profile based on input from
the local PNAC.
(d) Provider selection process. The LMHA shall inform
individuals, verbally and in writing, that they may choose to receive
services from any available provider in the LMHA's network that offers
the authorized services. The LMHA shall also provide individuals with
a neutral presentation of available providers consistent with the
plan to support consumer transition to the external network described
in subsection (f) of this section. When an individual is given the
opportunity to choose a provider, the LMHA shall:
(1) state that the individual may change providers
at any time;
(2) give the individual the provider list, provider
profiles, and a written copy of the procedures for requesting a change
in providers;
(3) allow a reasonable period of time and make an area
available for the individual to review the materials and make a decision;
and
(4) maintain documentation of the individual's choice
of provider.
(e) An LMHA shall not offer or schedule services before
the individual selects a provider. If an individual is unable to select
a provider or does not select a provider before leaving the first
appointment, the LMHA shall provide the consumer with an appointment
for ongoing services at an assigned provider. Except as provided in
subsection (f) of this section, assignments shall rotate equally among
all available external providers. In this situation, the LMHA shall
also provide the individual with information about how to have the
appointment rescheduled with a different provider.
(f) External network transition plan. The LMHA shall
develop and implement a plan to promote consumer transition to the
external network when a new provider joins the network.
(1) The plan shall be developed with input from the
LMHA's PNAC, any local consumer-operated organization, and its external
providers.
(2) LMHAs may emphasize benefits of receiving services
from an external provider, but shall not favor one provider over another
except to identify service sites that may be more convenient for a
client.
(3) The plan may include reassigning consumers to external
providers based on geographic proximity, but must give them the option
of choosing a different provider instead.
(4) The plan may include directing new individuals
to choose an external provider, but must give them the option of choosing
an LMHA service site instead.
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| Source Note: The provisions of this §301.277 adopted to be effective January 1, 2015, 39 TexReg 10478; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1237 |
